The State of Adolescent Health Services: How the System Fails Young People

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In the United States, we are about to engage in a potentially historic debate about long-overdue reform of our inadequate health care system, and big change may be on the way. That is exactly what we need because our current system is failing the very young and very old and everyone in between, including adolescents, a group we (mistakenly) don’t often associate with major health problems, much less as a priority in health reform.

How our system fails to deliver the best possible care to 42 million adolescents in the U.S., ages 10 to 19, is the subject of an illuminating and timely report released today by the respected Institute of Medicine (IOM) and National Research Council. Funded by Atlantic, this report, “Adolescent Health Services: Missing Opportunities”, was not cobbled together in a hurry to influence the new administration and Congress, but rather was in the works for more than two years and reflects a comprehensive review by an expert panel of all of the significant research evidence available. The contributors to this report were motivated by the desire to see our health care system invest in the nation’s future by ensuring that adolescents get the best care possible. Not surprisingly, the report finds the U.S. health care system woefully lacking for adolescents, and while it focuses on shortcomings related to young people, the report’s findings are relevant to the broader health reform debate and deserve our full attention.

When it comes to how the system treats young people, the specifics of the indictment are clear. At least five million adolescents lack health coverage of any kind. The care they receive for chronic illnesses, such as asthma, depression and diabetes, is often ineffective, and preventive care is nearly non-existent. At the heart of the problem is the dearth of well-trained health professionals who understand the particular needs of young adults, a lack of thoughtful co-ordination of care, and gaping chasms in private and public insurance programmes, which block millions of adolescents from consistent access to coverage and care. For instance, when many young people turn 18, they are dropped from their parents’ plans or public programmes, but they frequently cannot find affordable plans for themselves, so they go without health insurance. Add to this mix the fact that adolescents experience tough physical and emotional challenges during the transition to adulthood, sometimes take risks they should not, and often justifiably feel that health care professionals don’t understand them. The results are at times dramatic, even deadly, especially for young people from low-income families and communities of colour, who are the least likely to have access to coverage and care.

More than one-third of the adolescents who need treatment and care for depression, drug abuse and other behavioural problems don’t get any, leaving them vulnerable to suicide and accidents – two of the leading causes of adolescent death

Adolescents use emergency rooms for routine care more than members of any other age group, resulting in very expensive, sporadic and woefully ineffective care

The severe consequences of such gaps in care are made clear by the case of Marcus Campbell, pictured above, a young athlete who suffered for years from untreated asthma. He is one of three students featured in a video documentary released with the report. Marcus’s untreated asthma prevented him from playing sports and compelled him to visit emergency rooms nearly 15 times a year for the treatment of severe asthma attacks. “When I really had a bad attack,” said Marcus, “they would keep me in the emergency room for maybe 8 or 9 hours… But when I would leave the hospital, I knew I was going to be back.” Marcus knew he would return to the ER because he had no access to regular care and emergency health professionals never taught him how to manage his illness. That is, until tragedy struck. One night, Marcus’s 10 year-old brother, also severely asthmatic, died of an attack. After this completely preventable and devastating loss, the family was finally educated about how to avoid triggers that can lead to acute, deadly attacks. Now, Marcus is doing much better and is able to hit the basketball court with near abandon, and he even coaches youth basketball in his community.

Unfortunately, Marcus, his brother and other adolescents are not the only ones to suffer from gaps in coverage and a lack of high-quality care for chronic illness. More than 13 million people age 65 and over have three or more chronic conditions, and they too face similar challenges related to a lack of quality care, gaps in coverage, and a dearth of physicians trained to care for the special needs of older adults.

Clearly, our health care system is not delivering affordable, quality coverage for all. Overall, Americans are paying too much money for too little health care. Nearly 50 million Americans have no health coverage, and very few of those who have coverage get consistently top-notch care based on medical evidence, especially those people with one or more chronic illnesses. Both the systems for financing and the delivery of care in the U.S. are broken and need to be fixed, and that is why Atlantic is supporting Health Care for America Now (HCAN), a coalition of hundreds of advocacy organisations working to ensure that the new administration and Congress craft, pass and sign legislation in support of quality, affordable health care for all in the U.S. Furthermore, to address the health needs of adolescents through innovative approaches, Atlantic is supporting the Elev8 initiative in up to four states, which is working to provide comprehensive school-based health care to middle school youth. There is much that our elected officials can learn from the leaders of the Elev8 projects as they craft solutions aimed at ensuring that young people in their communities have access to quality health care.

These efforts and today’s new report from the IOM underscore the need to act on health care system reform and to do so both boldly and thoughtfully, accommodating the needs of everyone: young and old; blacks, Hispanics and whites; women and men; the disabled, chronically ill and healthy. In a recent conversation with Atlantic staff, the report’s authors acknowledged that many of the problems that adolescents face around access to quality care are similar to the problems that other groups face, including older adults. As members of President-elect Obama’s team and the new Congress prepare to fix the U.S. health care system, I recommend that they add the IOM’s report to their end-of-year reading lists and watch the accompanying DVD with their families. As a nation, we can do much better, and perhaps this time we will.

Coda

It is bittersweet that this report is sensitively dedicated to Debra Delgado, the programme executive in Atlantic’s Disadvantaged Children & Youth Programme who shepherded this project until her death a year ago at age 50 from cancer. Debra’s commitment to the health of young people was deeply felt and drove her to work on this and many other projects. Debra was one of the first in our office to pin a picture of Barack Obama on her bulletin board, and when we think of how this report may contribute to improvements in our health care system under President Obama, we can see Debra’s big smile in our mind’s eye. To read the full dedication to Debra, please click on this link.